What is Hemoptysis?

Hemoptysis is a process in which the respiratory organs below the throat (ie, the trachea, bronchi, or lung tissues) bleed and are expelled from the mouth by coughing. Hemoptysis can be caused not only by respiratory diseases, but also by circulatory diseases, trauma, and other systemic diseases or systemic factors. Should be distinguished from oral, pharyngeal, nosebleeds and vomiting.

Basic Information

English name: Hemoptysis
Visiting department: Respiratory Medicine
Common locations: Trachea, bronchi, lungs

Common causes: Respiratory diseases, circulatory diseases, trauma, systemic bleeding disorders, etc.
Common symptoms: Cough and bleeding, less sputum and more blood, or vomiting a lot of blood

Cause of hemoptysis

The diseases that cause hemoptysis are not limited to respiratory diseases, although hemoptysis is more common in respiratory diseases. The various diseases that cause hemoptysis are listed below.

Respiratory disease

Such as tuberculosis, bronchiectasis, bronchitis, lung abscess, lung cancer, pneumonia, pulmonary fluke disease, pulmonary amoebiasis, pulmonary hydatid disease, pulmonary fungal disease, pulmonary cysticercosis, bronchial stones, metastatic lung tumors, lung Adenoma, silicosis, etc. These inflammations lead to increased permeability of the bronchial mucosa or lesion capillaries, or rupture of the submucosal blood vessel wall, causing bleeding.

Circulatory system disease

Common mitral valve stenosis in rheumatic heart disease, hypertension heart disease, pulmonary hypertension, aortic aneurysm, pulmonary infarction and pulmonary arteriovenous fistula.

3. Trauma

Traumatic chest injuries, contusions, rib fractures, bullet wounds, explosive injuries, and medical procedures (such as thorax or lung puncture, biopsy, bronchoscopy, etc.) can occasionally cause hemoptysis.

4. Systemic bleeding tendency disease

Common examples include leukemia, hemophilia, aplastic anemia, pulmonary hemorrhagic leptospirosis, epidemic hemorrhagic fever, pneumonic plague, thrombocytopenic purpura, diffuse intravascular coagulation, chronic renal failure, uremia, etc. .

5. Other rare diseases or abnormal conditions

Such as alternative menstruation (not from vaginal bleeding), oxygen poisoning, pulmonary hemorrhagic nephritis syndrome, bronchiectasis, sinusitis, visceral translocation syndrome and so on.

Clinical manifestations of hemoptysis

Hemoptysis accompanied by fever is more common in tuberculosis, pneumonia, lung abscess, pulmonary hemorrhagic leptospirosis, epidemic hemorrhagic fever, bronchial cancer and so on.

Hemoptysis with chest pain is common in lobar pneumonia, pulmonary embolism, tuberculosis, and bronchial cancer.

Hemoptysis with cough can be seen in bronchial cancer and mycoplasma pneumonia.

Hemoptysis with bleeding from the skin and mucosa can be seen in hematological diseases (such as leukemia, thrombocytopenic purpura), leptospirosis, and epidemic hemorrhagic fever.

Hemoptysis with jaundice is more common in leptospirosis, lobar pneumonia, and pulmonary infarction.

Hemoptysis examination

1. Medical history inquiry

Bleeding was first or multiple. If it is multiple times, it is different from the past. Tuberculosis should be considered in young adults with cough and hemoptysis with low fever. Middle-aged people, especially male smokers, should pay attention to the possibility of lung cancer; they must carefully ask and observe the hemoptysis color and sputum, and pay attention to the history of tuberculosis exposure, the history of smoking, and the history of menstruation. Occupational dust exposure history, raw crab eating, etc.

Hemoptysis with chest pain is more common in pulmonary infarction and pneumococcal pneumonia; hemoptysis with cough is more common in bronchial lung cancer and blood sputum in lung abscess; a large number of hemoptysis is common in cavitary tuberculosis and bronchiectasis aneurysm rupture. Domestic literature reports that leptospirosis without jaundice also causes massive hemoptysis.

2. Physical examination

Patients with hemoptysis should be examined carefully and repeatedly. Some chronic heart and lung diseases can be combined with clubbing fingers (toes), and patients with progressive tuberculosis and lung cancer often have significant weight loss. Some blood disorders have systemic bleeding tendencies.

3. Laboratory inspection

Examination of sputum helps to find tuberculosis, fungi, bacteria, cancer cells, parasite eggs, heart failure cells, etc. Examination of bleeding time, clotting time, prothrombin time, platelet count, etc. helps diagnosis of bleeding disorders; red blood cell count As measured with proglobin, it helps to infer the degree of bleeding, and eosinophilia suggests the possibility of parasitic disease.

4. Instrument inspection

(1) X-ray examination: Patients with hemoptysis should have X-ray examination, chest radiography, chest plain tomography, and bronchography to assist diagnosis if necessary.

(2) CT examination can help find small bleeding lesions.

(3) Bronchoscopy : Patients with unexplained hemoptysis or broncho-obstructed atelectasis should consider bronchoscopy, such as tumors, tuberculosis foreign bodies, etc., while taking biopsy pathological examinations.

(4) Radionuclide gallium examination is helpful for the differential diagnosis of lung cancer and other lung masses.

Hemoptysis diagnosis

The diagnosis can be confirmed based on medical history, clinical manifestations and related examinations.

Differential diagnosis of hemoptysis

Need to be distinguished from vomiting.

Hemoptysis treatment

General treatment

Provide oxygen, monitoring, hemostasis, blood transfusion, infusion and symptomatic and etiological treatment.

2. Rescue of massive hemoptysis

Large hemoptysis should be rescued in time, otherwise the patient's life will be threatened.

The impact of massive hemoptysis on the human body, in addition to the amount of hemoptysis and the rate of bleeding, is also related to the general condition of the patient. If the patient is chronically weak, even bleeding less than 300 ml may be fatal.

The immediate danger caused by massive hemoptysis is mainly asphyxiation and hemorrhagic shock, and the indirect danger is secondary pulmonary infection or clot bronchus caused by atelectasis, and it can also be spread by blood through patients with tuberculosis.

(1) Keep your body sedated, don't panic, let the patient take a supine position, with your head tilted to one side, and encourage the patient to gently pull out the blood to prevent the blood from staying in the respiratory tract. If the lesion is known, take the affected side in a supine position to prevent blood from flowing into the healthy lung. If the bleeding site is unknown, take a supine position with your head to one side to prevent suffocation.

(2) Sedation to avoid mental tension, give spiritual comfort, and if necessary, give a small amount of sedatives, such as oral stabilization.

(3) Patients with severe cough who have severe coughing hemoptysis may give an appropriate amount of antitussive drugs, but must be cautious and prohibit severe sedative cough medicines, so as not to inhibit the cough center excessively, causing blood to stagnate the airway and cause suffocation.

(4) Observe the condition closely observe the hemoptysis, breathing, pulse and other conditions of the patient to prevent the occurrence of shock.

(5) Do not forcefully defecate to prevent heavy stools from aggravating hemoptysis.

(6) Keep the airway unobstructed. If the patient feels chest tightness, shortness of breath, or wheezing, help the patient to clear the mouth and nose secretions, maintain indoor air circulation, and give oxygen when possible.

(7) Rescue of patients with asphyxia. If massive hemoptysis occurs, immediately drain the body, take the head low and high (you can raise the end of the bed by about 45 degrees), or pat the back side.

After preliminary treatment, hemoptysis is slightly relieved. When the patient's blood pressure, pulse and breathing are relatively stable, the patient should be escorted to the nearby hospital as soon as possible for further treatment; if the bleeding does not stop, please call the emergency doctor at the emergency center for on-site rescue. When transfer is allowed, it still needs to be sent to the hospital for oxygen inhalation, monitoring, hemostasis, blood transfusion, infusion and symptomatic and etiological treatment.